Behavior Rating Inventory of Executive Function BRIEF Behavior Rating Inventory of Executive Function BRIEF TM Gerard A. Gioia Peter K. Isquith Steven C. Guy Lauren Kenworthy Kimberly Espy

Impetus: u Clinical need for external validation, ecological validity, real-world anchor u Common parent descriptions u ALL research - observations u Performance tests vs rating scales

What’s in a name ? Children’s Behavior Questionnaire ? Executive Function Questionnaire ? Developmental Executive Function Test ? Behavioral Evaluation of Executive Function (Youth?) ? Behavioral Assessment of Regulatory Function ? Planning and Organization Rating Questionnaire ? Parent Observation Rating Questionnaire ¢ Behavior Rating Inventory of Executive Function

The Purpose is to provide a measure of executive function that is: u psychometrically sound u sensitive to developmental changes u high in ecological validity u sufficiently broad to serve as a screen u comprehensive in sampling content u theoretically coherent u useful in targeting treatment

Behavioral Definitions for Executive Function Domains u Inhibit - Control impulses; stop behavior u Shift - Move freely from one activity/situation to another; transition; problem-solve flexibly u Emotional Control - Modulation emotional responses appropriately

Behavioral Definitions for Executive Function Domains u Initiate - Begin activity; generate ideas u Working Memory - Hold information in mind for purpose of completing a task u Plan/organize - Anticipate future events; set goals; develop steps; grasp main ideas u Monitor - Check work, assess own performance

Development of the BRIEF u Content u Reliability u Validity u Age/ Gender Findings u Modeling of Executive Function

Item Development u Collected items from clinical work u Idea generation sessions within group u Requests from colleagues u Review of behavior scales (CBCL/TRF, BASC, Conner’s, Vineland, Profile of Executive Control System, Cognitive Symptom Checklist)

Results of Item Development Items reviewed by group, colleagues, reading specialists: 180 initial items: redundant & non-specific Item Tryout: 129 Parent/127 Teacher Excess items based on item-total correlations Final Scale: 90 items retained

BRIEF: Inhibit u Gets in your face u Has trouble stopping when silly u Is squirmy u Does not stop laughing at joke when friends stop u Has to be closely supervised u Des not think before doing u Acts wilder or sillier than others in groups u Makes odd noises, hums, mutters or sings u Interrupts others

BRIEF: Shift u Does same thing over and over for no apparent reason u Is stubborn u Cannot get a disappointment off their mind u Resists accepting a different way to solve a problem u Becomes upset with new situations u Tries same approach to problems even when it doesn't work u Acts upset by change in plans u Not creative in problem solving

BRIEF: Emotional Control u Overreacts to small problems u Explosive, angry outbursts u Tearful easily u Mood changes frequently u Reacts more strongly than other children u Becomes too silly

BRIEF: Initiate u Is not a self-starter u Needs to be told to begin a task even when willing u Has trouble coming up with ideas for what to do in play or free time u Has trouble getting started on homework or chores u Does not take initiative u Complains there is nothing to do u Lies around the house a lot (couch potato)

BRIEF: Working Memory u Is absent-minded u When given three things to do, remembers only the first or last u Trouble with multi-step chores u Forgets when he was doing u Trouble remembering things even for a few minutes u Has a short attention span u Has trouble completing tasks u Is easily distracted

BRIEF: Plan/Organize u Tests poorly despite knowing answers u Good ideas but can't get the job done u Written work poorly organized u Starts project without the right materials u Trouble planning for future play activities u Does not connect tonight's homework with grades u Unrealistic Goals u Underestimates time needed to complete tasks

BRIEF: Organization of Materials u Leaves playroom a mess u Loses lunch box, lunch money, permission slips, homework u Cannot find clothes, glasses, shoes, toys, etc u Backpack is disorganized u Forgets to hand in homework even when completed

BRIEF: Monitor u Doesn't ask for help when needed u Doesn't check work for mistakes u Makes careless errors u Poor handwriting u Unaware of how behavior affects others u Leaves work incomplete

Reliability: Internal Consistency Initiate Working Memory Plan/Organize Organization of Materials MonitorInhibitShift Emotional Control ParentTeacher

Reliability: Internal Consistency Metacognition Behavioral Regulation Global Executive Composite ParentTeacher

Reliability: Test-Retest ScaleInitiate Working Memory Plan/Organize Org of Materials MonitorInhibitShift Emotional Control ParentParentTeacher ClinicalNorm Norm

Reliability: Test-Retest Metacognition Behavioral Regulation Global Executive Composite ParentParentTeacher ClinicalNorm Norm

Validity u Content Item development Expert Agreement Item-Total Correlations u ConstructMultitrait-Multimethod Matrix Factor Structure Clinical Group Comparisons

Construct Validity - Factor Analysis u Allows examination of the structure of the BRIEF to assist in clinical scale/ index development u Resulting factors can serve as clinical entities; meta-scale (latent) structural factors u Various extraction methods: PFA, PCA u Various rotational methods: Varimax, oblique

Summary of Exploratory FA Consistent 2-factor model found with normative, clinical samples; BRIEF factors differentiate from other behavior rating scale factors. u Metacognition 3 Initiate, Working Memory, Plan/Organize, Organization of Materials, Monitor 3 (Inhibit) u Behavioral Regulation 3 Inhibit, Shift, Emotional Control 3 (Monitor)

The Structure of Executive Function u Interest in BRIEF goes beyond its use as a clinical tool u Allows an opportunity to explore the theoretical structure of executive function (EF) u Others have asked whether EF is a unitary or “fractionated” supervisory/ regulatory system u Theory testing also can assist our approach to clinical application of the BRIEF as a measure of EF

Diagnostic Group Studies u ADHD-Inattentive vs ADHD-Combined 3BRI and Monitor: Combined > Inattentive & Controls 3MCI: Both ADHD groups > Controls B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. GuyB. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. Guy P. Isquith, G. Gioia & S. GuyP. Isquith, G. Gioia & S. Guy u Severe vs Mild/Moderate TBI 3BRI & Init, Plan/Org, WM, Monitor: Severe > Controls 3Working Memory: Severe > Mild/Moderate > Controls H. G. Taylor et al.H. G. Taylor et al. u TS vs ADHD vs TS+ADHD 3BRI & MCI: ADHD & TS+ADHD > TS & Controls E. M. MahoneE. M. Mahone

Diagnostic Group Studies u Reading Disorders 3Working Memory: Reading > Controls 3Plan/Organize: Reading > Controls B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. GuyB. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. Guy u Extremely Low Birth Weight vs VLBW 3Monitor, WM, Shift, Inhibit, Init, Plan/Org: ELBW > Controls 3Initiate & Plan/Org: ELBW > VLBW. G. Taylor et al.. G. Taylor et al. u Mental Retardation 3Working Memory: MR > Controls B. Pratt & T. ChapmanB. Pratt & T. Chapman

Diagnostic Group Studies u High Functioning Autism 3All BRIEF Scales: HFA > Controls R. Landa & M. GoldbergR. Landa & M. Goldberg u Pervasive Developmental Disorders 3All BRIEF Scales: PDD > Controls L. Kenworthy & S. GuyL. Kenworthy & S. Guy u Frontal vs Extrafrontal Lesions 3All Scales: Frontal & Extrafrontal > Controls 3Inhibit:Frontal > Extrafrontal > Controls R. Jacobs, V. Anderson, S. HarveyR. Jacobs, V. Anderson, S. Harvey

Conclusion “ The BRIEF is a reliable and valid behavior rating scale of executive functions in children and adolescents that can (a) become an integral part of the clinical and school assessment of children and adolescents and (b) assist with focussed treatment and educational planning for children with disorders of executive function.” (Gioia, Isquith, Guy & Kenworthy, 2000, p. 4)

Clinical Implications u Two factors and component parts are to be considered in interpretation u Behavioral Regulation, esp. Inhibit, must be considered first prior to Metacognition u Treatment of Behavioral Regulation is likely a necessary precursor to Metacognition treatment u Treatment of metacognition via active problem-solving strategies

BRIEF Administration and Scoring

u Intro to Forms - Parent, Teacher u Scoring Sheet u Scoring Summary u Profile Sheet u Case Example

Steps to BRIEF Interpretation u Examine validity scales 3Inconsistency 3Negativity u Examine clinical scales u Examine Indexes, Global Executive Composite u Individual item analysis 3Within scale items 3Non-scale items

Son of BRIEF: The BRIEF-Preschool Version Gerard A. Gioia Kimberly Andrews Espy Peter K. Isquith

Or: The Developmental Inventory Assessment of Preschool Executive Regulation (DIAPER)

Executive Function in Preschoolers: Common View u Young children: 3 lack inhibitory control 3exhibit significant distractibility 3have difficulty shifting among tasks 3do not organize, plan, or monitor their actions or performance

Views from Developmental Neuropsychology u Executive functions DO originate in infancy u BUT, not available in full final form u HOWEVER, measurement is possible if developmentally appropriate tasks are used u AND, we must take into account the preschooler’s behavioral repertoire

BRIEF-Preschool Version u Sample: n=450 Parents, 300+ Teachers 3Age 2- 5 years 3Diverse sample: ethnically, regionally, SES u items

BRIEF-P Domains 3Inhibit 3Shift 3Emotional Control 3Working Memory 3Plan/ Organize 3Organization (of Materials) 3Monitor 3Initiation

Reliability: Internal Consistency Working Memory (17) Plan/Organize (10) Inhibit (16) Shift (10) Emotional Control (10) ParentTeacher

Stability of Preschool Executive Behaviors: Test - Retest Reliability Scale r Inhibit.90 Shift.88 Emotional Control.87 Working Memory.85 Plan/Organize.78 Test-Retest Interval weeks, M = 4.5 weeks

BRIEF-P Construct Validity u Factor 1 = Emergent Metacognition; u Factor 2 = Flexibility u Factor 3 = Inhibitory Self-Control.

Diagnostic Group ScaleControlsPreemieLanguageADHDPDD Inhibit Shift Emotional Control Working Memory Plan/Organize Inhibitory Self-Control Index Flexibility Index Emergent Metacognition Index Global Executive Composite Percentage of Dx Groups With T> 65 on BRIEF-P Scales

Clinical vs Control Samples * * * * * * p <.001

Bride of the BRIEF The BRIEF-Self-Report

Scale Number of ItemsBehavioral description Clinical scales Inhibit13 Controls impulses and behavior; appropriately stops and modulates own behavior at the proper time or in the proper context. Shift10 Moves freely from one situation, activity, or aspect of a problem to another as the situation demands; makes transitions; solves problems flexibly. *Behavioral Shift5 Adjusts behaviorally to changes in environment or schedule. *Cognitive Shift5 Problem solves flexibly. Emotional Control10 Modulates emotional responses appropriately to situational demand or context. Monitor6 Aware of strengths and weaknesses; aware of own behavior and impact on others. Working Memory12 Holds information in mind for the purpose of completing a task or making the appropriate response; stays with, or sticks to, an activity. Plan/Organize13 Anticipates future events or consequences; uses goals or instructions to guide behavior in context; develops or implements appropriate steps ahead of time to carry out an associated task or action. Organization of Materials 7 Keeps work and school materials organized; able to organize environment such as backpack and room. Task Completion10 Completes school work or chores in timely fashion; finishes tests within time limits; works at a satisfactory pace.

Scale/Index# Itemsα Inhibit Shift Behavioral Shift 5.74 Cognitive Shift 5.72 Emotional Control Monitor 6.75 Working Memory Plan/Organize Organization of Materials 7.75 Task Completion Behavioral Regulation Index Metacognition Index Global Executive Composite Internal Consistency

Scale/Indexrara Inhibit.77 Shift.71 Behavioral Shift.69 Cognitive Shift.65 Emotional Control.84 Monitor.59 Working Memory.85 Plan/Organize.77 Organization of Materials.79 Task Completion.82 Behavioral Regulation Index.84 Metacognition Index.87 Global Executive Composite (GEC).89 Test-Retest Reliability

Parent vs Self-Report BRIEF: u Correlations ranged from.25 (Inhibit) to.64 (Working Memory) u Parent ratings higher for Metacognition u Children’s ratings higher for behavioral regulation u Neither Parent nor Child BASC were elevated

BRIMIGEC Behavioral Regulation Index.52 Metacognition Index.57 Global Executive Composite (GEC).56 Parent-Self Correlations for Indexes

Parent & Self Reports in Adolescents with ASD

Case Examples u Joshua - 8 year old left handed male, Attention Deficit Hyperactivity Disorder, Attention Deficit Hyperactivity Disorder, Combined Type Combined Type u Juan - 12 year old male, Traumatic Brain Injury at age 5 years Injury at age 5 years

Joshua ADHD - Combined Type

Joshua

Juan Traumatic Brain Injury

Juan